My sincerest apologies for not writing a blog entry sooner.
The past week has been dreadful. Kristine has been struggling with those awful mouth and throat sores. Eating and drinking is like trying to swallow a mouthful of razor blades. Yet she continues to push through at least one meal a day to keep something in her stomach with all the medications being administered to her. They were giving her dilaudid but that was causing her to vomit after each dose. The doctor decided to switch her to morphine. He eventually had the nurse give Kristine a "PCA" which stands for patient controlled anesthesia. Now she can give herself a little dose of morphine without having to wait for her nurse to bring her an injection.
In my last blog entry, I stated I would provide detailed info about stem cell transplantation. Here we go...
Bone marrow is the spongy tissue inside the bones which manufactures the cells of the blood and the immune system: white blood cells, red blood cells and platelets. Each of these different types of cells has a vital role to perform in keeping the body healthy and free of disease. In leukemia, the white blood cells become malignant and multiply constantly. Their overgrowth hinders production of normal blood cells by the bone marrow and leukemia cells invade other tissues. If unchecked these cancer cells can lead to death. Chemotherapy drugs can destroy malignant cells but also destroy the normal bone marrow cells as well. In standard treatments for leukemia, the dosages of chemotherapy drugs must be kept low enough so they are not too poisonous to the normal bone marrow, which must continue to produce blood cells once the malignant cells have been destroyed.
With transplants, very large and more effective doses of chemotherapy and/or radiation are administered to eradicate the malignancy. In allogeneic bone marrow transplant, this treatment also suppresses the patient's immune system to prevent the donor marrow from being rejected by the recipient. The transplanted marrow seeks out its place within the bone and begins to produce blood cells from the donor. When the marrow "engrafts" successfully, the leukemia does not recur and the patient has a chance of long-term survival.
Kristine received an allogeneic transplant with donated peripheral blood stem cells from our sister, Kat. I explained that procedure in a previous entry.
The body's immune system consists of white blood cells, which travel throughout the body in constant surveillance against foreign substances, which might be disease agents. These cells react and try to destroy anthing they perceive as foreign. As a result, tissues of one individual will be rejected when transplanted into another person, unless the receipient's immunity is suppressed by drugs or radiation. This is why Kristine was admisistered the high dose chemo treatments immediately before transplantation. In allogeneic transplants, the donor's marrow (Kat's) contains cells of her immune system; they may recognize the transplant recipient (Kristine) as "foreign" and cause an immune reaction against the recipient's tissues producing graft versus host disease (GVHD). To reduce the risk of GVHD after transplantation, Kristine is receiving immunosuppressive drugs.
Kristine will remain in the hospital for 2-4 weeks after transplant day (June 3rd), waiting for the marrow to engraft and to recover blood counts. She will be discharged when she has met certain criteria, which includes when the blood counts have recovered, she is able to eat adequately and is free of infections. Upon discharge, she'll still be at risk for infections and complications, and will need to be monitored frequently by the doctors. This is why she will then transfer to the Tiverton House which is within walking distance of the UCLA Medical Center. She will need frequent blood tests, some intravenous medications and may also need more blood transfusions. She is expected to be at the Tiverton House for at least 4 weeks.
Kristine is expected to need a full year to recover physically and psychologically after transplant. It is not unusual to require another hospitalization during this time. It may be necessary to take medications indefinately.
I'm exhausted, so I'm going to wrap it up for now and continue in the morning.
Sending lots of love and hugs to all our prayer warriors out there. Please continue to pray for Kristine and send your positive thoughts her way.
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